President's Student Emergency Fund Application
Please review eligibility requirements and additional information at
Date of Birth
Please provide a brief statement explaining why you are requesting emergency funding.
Please list the expense(s) and amount(s) for which you are requesting assistance.
Please provide a brief explanation of your financial circumstances, and describe your efforts to obtain funds and/or support through other sources.
If applicable, please provide the name and contact information for the provider/vendor to whom funds may be directly distributed. (For example: funding for temporary rent will be paid directly to landlord.)
Please email copies of the following documents, if applicable, to Nelson Lopez at
- Copy of Rental/Lease Agreement
- Mortgage Statement
- Utility Statement
- Recent Billing Statement
- Other pertinent documentation
By submitting this form, I certify that:
● The information is complete and accurate.
● I will use Student Emergency funds only for the purpose(s) specified.
● I will submit receipts or other documentation as requested.
● I am aware that although it is not HCC’s policy to reduce financial aid awards when a student receives a private subsidy, there are limited occasions when the college is required by regulations to make adjustments. Whenever possible, any necessary adjustment is made by reducing student loan awards. I understand that accepting this subsidy could require the school to make an adjustment to my financial aid. (Please consult the Financial Aid Office to determine if your grant or loan will be affected.)
Students will receive an acknowledgment by email, typically within 1 business day, with information about any next
steps. Once an application for funding has been approved, every effort will be made to provide the student with funding within 3 business days.
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This form was created inside of Holyoke Community College.